GPs outnumbered on commissioning group boards

GPs in minority on 44% of CCG boards, as hundreds of managers appointed

Some CCGs have just two or three GP board members

CCGs fail to include hospital consultants

GPs have taken less than half of the seats on the new boards of clinical commissioning groups (CCGs), and in some parts of the country make up just a fifth of boards, a Pulse investigation reveals.

Our analysis of more than 1,300 board positions, based on data released under the Freedom of Information Act from 100 CCGs, is the most comprehensive to date of the leadership of CCGs, which will assume responsibility for commissioning from April 2013.

It shows practices risk being forced out of the commissioning process as CCGs struggle to keep down costs, minimise conflicts of interest and engage grassroots GPs. In some areas, financial restraints have forced CCGs to actively cut the number of GPs on their boards, despite health secretary Andrew Lansley’s insistence that it is GPs who are ‘best placed’ to improve NHS commissioning.

On 44% of CCG boards fewer than half of members were GPs. CCGs with the lowest proportion of GPs included Nottingham West, which had two GPs (20%); Bury, with three GPs (21%); and Newcastle, also with three GPs (21%).

Across the country, just a third of CCGs’ accountable officers were GPs.

The investigation also reveals:

Hospital doctors are not being involved in commissioning, despite the Department of Health’s requirement that each board should include a consultant. Only 36 out of 100 CCGs have reserved a position for a secondary care doctor – and just seven positions have been filled.

Only a third of CCG board members - and just 21% of CCG chairs – are women.

75% of GPs on CCG boards were elected, although two-thirds stood unopposed. Of those who were elected just a third will face re-election before the CCG takes on commissioning responsibility, despite the BMA insisting all should.

Dr Guy Mansford, clinical lead and deputy chair of Nottingham West CCG, told Pulse practices in his area had agreed to cut the number of GP board members from five to two to reduce costs and the likelihood of the board being accused of having a conflict of interest: ‘With a large board there is a massive workload for governance, and innovation was just going out of the window. For small CCGs trying to live within the £25 per head budget, it is very hard to do everything.’

Bob Senior, head of medical services at RSM Tenon and chair of the Association of Independent Specialist Medical Accountants, said the £25 management allowance was a factor in the composition of many boards: ‘The economies of scale don’t work so smaller [CCGs] are having to use that money judiciously, which means you can’t have quite as big an involvement from GPs.’

But Dr George Rae, secretary of Newcastle and North Tyneside LMC, warned the balance had swung too far: ‘If it is GP-led commissioning, the correct balance isn’t GPs in the minority. There are other people who have to have input, but we must not sell ourselves short.’

Steve Nowottny, acting editor of Pulse, said: ‘CCG boards have been coming together over the last few months largely under the radar, but they will be responsible for an estimated £60bn budget and play an absolutely pivotal role in the new NHS.’

‘It is right there should be a wide range of people on CCG boards – and there is clearly a real challenge to get more hospital consultants involved. But these figures show that the balance has swung too far in the other direction. The main driver for Andrew Lansley’s reforms was to put budgets in the hands of frontline clinicians – if GP-led commissioning is to have any chance of succeeding, it must be led by GPs.’